In this lesson, we'll cover how to perform CPR on a child. Much of the process will look the same as adult CPR, but there are some subtle yet crucial differences to take note of.
Like in the last lesson, we'll assume that in this scenario, a child has suddenly collapsed and you don't know why.
Pro Tip #1: The victim could be in this condition for any number of reasons and it's not a bad idea to consider some of these when you're doing your assessment of the scene and the victim. Is there a live electrical wire nearby? Could the victim have been bitten by a snake? (Incidentally, these two fictional scenarios also drive home the point of scene safety.)
Regardless of what led to the child's condition, all you know for sure is that the victim is unresponsive and not breathing normally, if at all. And that CPR is required.
What is a Child?
According to guidelines, a child is anyone from one-year to the first signs of puberty. And if you just wondered about ambiguity, you'd be correct to be concerned.
Let's say puberty begins around age 14. This can still be problematic since some 14-year olds are tiny, while others are bigger than many adults. Which is why it's a better idea to judge the victim by size rather than by age. This should also help reduce wasted time. Instead of having to think about it, just look, decide, and begin.
Pro Tip #2: To complicate matters further, the size of your hands also matters. You see, the size of the patient determines whether you use two hands during chest compressions or just one, which means it's much more a matter of ratio (your hand size to their chest size), than it is their size alone. So, perhaps a better way of deciding whether the victim is "adult-size" or "child-size," is to see how your hands fit over their compression point.
Depth Compression Matters
The compressions you perform on a child are very similar to those you would perform on an adult. The only difference is in the compression depth. While adult CPR has a depth of 2-2.4 inches, when administering CPR on a child, two inches will usually be the maximum depth.
Pro Tip #3: While two inches may represent an average chest compression depth for children, it's best not to use a fixed depth. Instead, compress to a depth 1/3 the depth of the chest when performing CPR.
How to Provide Care
Of course, the first thing you want to do is make sure the scene is safe, your gloves are on, and that you have your rescue shield available and begin calling out to the victim to assess whether or not he or she is responsive.
Are you OK? Can you hear me?
If you don't get an initial response, place your hand on the victim's forehead and tap on his or her collarbone. If you still do not get a response, proceed with the following steps.
- Call 911 and activate EMS. If there is a bystander nearby, you can ask for their help – calling 911, locating an AED, etc.
Remember, as long as you have your cell phone, you're never alone. If no one is around to help you and you aren't sure what to do, call 911 on your cell phone, put it on speaker, and follow their instructions. Dispatch can help coach you through the situation.
- If you've determined at this point that the victim is unresponsive and not breathing normally continue immediately with CPR, beginning with chest compressions.
Remember your landmarks, which don't change when performing CPR on children: Aim for the center of the chest, between the nipples and on the lower one-third of the sternum.
Hand placement: If you've determined that you should use two hands, based on the size of the victim, place your first palm on that landmark, just as you would for adults, and interlock the fingers on your top hand over your first.
One-Hand placement: Place your first palm on the same landmark … and that's it.
- Lean over the victim, position your hand(s) as indicated above, and in the video, and lock your elbows.
- Use your upper body weight to supply the force needed for chest compressions and compress at a depth equal to 1/3 the depth of the child's chest.
- Perform 30 chest compressions at a rate between 100 – 120 compressions per minute, which amounts to around two compressions every second. Remember to allow the child's chest to come all the way back up before performing your next compression.
Remember, to maintain a steady rhythm, count out loud while performing chest compressions – one, as you press down, and, as you allow the chest to recoil. When you reach 13, drop the and to maintain a two-syllable cadence on the compressions and not disrupt the rhythm.
- Lift the child's chin and tilt his or her head back slightly.
- Grab the rescue shield and place it over the victim's mouth and nose.
- Pinch the child's nose and open their mouth.
- Deliver two rescue breaths – Breathe into the rescue mask and wait for the chest to rise and fall before administering the next breath.
Don't forget to watch the victim's chest when performing chest compressions. If the chest doesn't rise, then you might be dealing with another problem and one that likely includes an obstructed airway.
- Go right back into 30 chest compressions followed again by two rescue breaths.
Continue to perform 30 chest compressions to two rescue breaths until EMS arrives, an AED is located, someone equally trained relieves you, or the victim becomes responsive and begins breathing normally again.
